Key result
Post-PCI major bleeding is linked to a ~4-fold increase in 30-day MACCE risk.
Why the study?
Bleeding severity defined by BARC portends adverse prognosis in patients undergoing PCI, prompting investigation into its association with short-term clinical outcomes.
Does major bleeding (BARC 3&5) following percutaneous coronary intervention increase the risk of short-term major adverse cardiac and cerebrovascular events?
Cohort (n=37,866)
Yes
Does major bleeding (BARC 3&5) following percutaneous coronary intervention increase the risk of short-term major adverse cardiac and cerebrovascular events?
Odds Ratio: 4.37 (95% CI 3.2–5.98)
p-value: p=<0.001
Major bleeding after PCI is an uncommon but potentially fatal complication that independently predicts worse short-term clinical outcomes, underscoring the importance of bleeding mitigation strategies like radial access.
Major bleeding after PCI was associated with higher short-term MACCE; hypothesis-generating for bleeding mitigation trials.
Bleeding severity in patients undergoing percutaneous coronary intervention (PCI), defined by the Bleeding Academic Research Consortium (BARC), portends adverse prognosis. We analysed data from 37,866 Australian patients undergoing PCI enrolled in the Victorian Cardiac Outcomes Registry (VCOR), and investigated the association between increasing BARC severity and in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) (a composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, or stroke). Independent predictors associated with major bleeding (BARC groups 3&5), and MACCE were also assessed. There was a stepwise increase in in-hospital and 30-day MACCE with greater severity of bleeding. Independent predictors of bleeding included female sex (Odds Ratio (OR) 1.34), age (OR 1.02), fibrinolytic therapy (OR 1.77), femoral access (OR 1.51), and ticagrelor (OR 1.42), all significant at the p < 0.001 level. Following adjustment of clinically important variables, BARC 3&5 bleeds (OR 4.37) were still predictive of cumulative in-hospital and 30-day MACCE. In conclusion, major bleeding is an uncommon but potentially fatal PCI complication and was independently associated with greater MACCE rates. Efforts to mitigate the occurrence of bleeding, including radial access and judicious use of potent antiplatelet therapies, may ameliorate the risk of short-term adverse clinical outcomes.
No takes yet. Share an insight, caveat, or question.
Murali et al. (2020) conducted a cohort in Percutaneous Coronary Intervention (PCI) (n=37,866). Major bleeding (BARC groups 3 & 5) vs. No bleeding (BARC 0) or minor bleeding (BARC 1 & 2) was evaluated on Cumulative in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) (OR 4.37, 95% CI 3.20-5.98, p=<0.001). Major bleeding (BARC 3&5) after percutaneous coronary intervention was independently associated with a significantly increased risk of cumulative in-hospital and 30-day major adverse cardiac and cerebrovascular events (OR 4.37).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: